Form NHTSA Form 1182 NHTSA Form 1182 Impaired Driving Survey

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery_ Survey Instrument

OMB Control No. 2127-0682

Expiration Date 02-28-2015

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0682. Public reporting for this collection of information is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590

Thank you for taking this short survey. Your answers are anonymous and confidential, and none of your answers will be shared with any third parties. Please be honest when answering the questions.

Q1. Today, we are looking for people who work in certain industries or fields. Are you, or is any member of your immediate family or close friends employed in any of the following sectors?

1 TV/Radio/Press/Newspaper/ Magazine

2 Travel agency

3 Ad agency/Public Relations

4 Banking

5 Market Research/Marketing Consulting

6 Agriculture

7 Production or distributor of alcoholic beverages

8 Drug and Health Related Products Distributor

9 Insurance

10 Medical Field

11 None of the above

PROGRAMMING NOTE: If 1, 3, 5, or 7 checked Terminate

AC10. What is your gender?

1 Male

2 Female

AC11. What is your exact age? _________

(PROGRAMMER NOTE: MUST BE 21 OR OLDER; else Terminate)

AC18. Are you of Hispanic or Latino origin?

1 Yes

2 No

AC19. What is your race? Please select one or more.

1 White

2 Black or African-American

3 Asian

4 Native Hawaiian or other Pacific Islander

5 American Indian or Alaska Native

6 Prefer not to state

AC17. What is the highest level of education that you have completed?

1 8^th grade or below

2 9th grade to 11th grade

3 High school graduate

4 Some college

5 Associate's degree

6 Bachelor's degree

7 Some postgraduate study

8 Graduate-school degree

9 Trade school

10 None of the above/Prefer not to state

AC20. Which classification best describes your total pre-tax household income?

Under $10,000 [0]

$10,000-$19,999 [1]

$20,000-$29,999 [2]

$30,000-$39,999 [3]

$40,000-$49,999 [4]

$50,000-$74,999 [5]

$75,000-$99,999 [6]

$100,000-$124,999 [7]

$125,000-$149,999 [8]

$150,000-$174,999 [9]

$175,000-$199,999 [10]

More than $200,000 [11]

Prefer not to state [12]

Q3. What is your current employment status?

1 Employed full-time

2 Employed part-time

3 Temporarily unemployed

4 Full-time student

5 Part-time student

6 Retired

[PROGRAMMER NOTE: ASK Q4 IF 1 OR 2 IS CHECKED IN Q3]

Q4. What is your occupation? (Read list and record one answer below.)

1 Professional (such as a doctor, lawyer, accountant, consultant)

2 Executive/Manager

3 Technical (such as a computer programmer, medical technician)

4 Services

5 Clerical

6 Sales/Advertising/Marketing

7 A trade, such as plumber or electrician

8 Laborer

9 Other

10 Prefer not to answer

[PROGRAMMER NOTE: ASK Q5 IF 1 OR 2 IS CHECKED IN Q3]

Q5. Is the type of work you do compensated on:

1 A salary, that is exempt from overtime

2 An hourly basis, that is non-exempt from overtime

Q6. Which of the following activities do you do frequently, meaning at least three or four times a week?

Working out	Yes	No
Driving an automobile	Yes	No
Reading a book	Yes	No
Watching the news on TV	Yes	No

[Must select “yes” to ‘driving an automobile’ to continue]

Q7. Which of the following types of foods and beverages do you consume at least occasionally, meaning at least once a month?

Juice	Yes	No
Soy Milk	Yes	No
Alcoholic beverage	Yes	No
Soda	Yes	No
Coffee	Yes	No

[PROGRAMMER NOTE: Must say “yes” to Alcoholic beverage to continue]

Q8b. Different people make different decisions about the amount of alcohol that they will drink if they know they will be driving afterwards. If you are at a social occasion lasting a few hours, about how many drinks do you typically allow yourself if you are planning to drive home afterwards?

1 1 drink

2 2 drinks

3 3 drinks

4 4 drinks

5 5 drinks

6 6 drinks

7 7 drinks

8 8 drinks

9 9 drinks

10 10+ drinks

11 I never drink any alcohol if I need to drive afterwards

Q9. When people are out socializing and having a few drinks, there may be times when they feel “buzzed” or somewhat impaired, even though they do not feel drunk or out of control. If you have driven somewhere to socialize and you are feeling “buzzed” or somewhat impaired, how likely is it that you will drive yourself home?

1 Extremely likely

2 Very likely

3 Somewhat likely

4 Not too likely

5 Not at all likely

6 Not applicable – I never drink any alcohol if I need to drive afterwards

Q10. And if you are out socializing and feeling “buzzed” or somewhat impaired, which statement best describes you?

1 I’ll drive without worrying too much about it

2 I’ll drive even though I worry about it

3 I’ll always get a ride from a friend, get a taxi or use public transportation

4 Not applicable – I never drink any alcohol if I need to drive afterwards

Q10a. And when it comes to the friends you socialize with, which statement generally best describes what they would do if they were feeling “buzzed” or somewhat impaired?

1 My friends will generally drive without worrying too much about it

2 My friends will generally drive even though they would worry about it

3 My friends will generally get a ride from a friend, get a taxi or use public transportation

4 Not applicable – My friends generally never drink any alcohol if they need to drive afterwards

Q11. As an issue in your community, how personally concerned are you about drunk driving prevention?

1 Extremely concerned

2 Very concerned

3 Somewhat concerned

4 Not too concerned

5 Not at all concerned

Q11a. In your community, if somebody drives drunk, how likely do you think it is that he or she will get caught by law enforcement?

1 Extremely likely

2 Very likely

3 Somewhat likely

4 Not too likely

5 Not at all likely

Q12. How much do you agree or disagree with the following statements?

[RANDOMIZE STATEMENTS]	1 Disagree strongly	2 Disagree somewhat	3 Agree somewhat	4 Agree strongly	5 Not sure
A. There was a time recently when I probably had too much to drink before getting behind the wheel
B. There was a time recently when I decided to NOT drive after drinking
C. I’m confident in my ability to tell when I am too impaired to drive
D. I know when I am over the legal blood alcohol limit for driving
E. The legal blood alcohol limit for driving in my state is too strict
F. I don’t drink too much and drive, but many of my friends do

Q13. Have you recently done any of the following? (Please check all that apply.)

A. Discussed the risks of drinking and driving with a friend or family member	Yes	No
B. Stopped an impaired friend or family member from driving after drinking	Yes	No
C. Cut down on drinking alcoholic beverages while out socializing	Yes	No

Q14. In the past, have you ever been in a situation where you decided to

NOT drive after drinking, even though you had originally planned to drive?

1 Yes

2 No

[PROGRAMMER NOTE: IF YES to Q14 THEN ASK Q15]

Q15. When was the last time this happened?

1 About a week ago

2 A few weeks ago

3 A month ago

4 A few months ago

5 A year ago

6 A few years ago

7 Not sure

Q16. In the past, have you ever tried to stop someone who was about to drive after drinking?

1 Yes

2 No

[PROGRAMMER NOTE: F YES TO Q16 THEN ASK Q17]

Q17. When was the last time you tried to stop someone who was about to drive after drinking?

1 About a week ago

2 A few weeks ago

3 A month ago

4 A few months ago

5 A year ago

6 A few years ago

7 Not sure

Q18. Have you seen, heard or read anything about drunk driving prevention anywhere recently including all the different kinds of advertising, publicity and other activities that talk about it?

1 Yes

2 No

3 Not sure

[PROGRAMMER NOTE: IF “Yes” TO Q18 THEN ASK Q19]

Q19. (Where was that…? (Accept multiple responses.)

A. TV Program	Yes	No
B. TV Ad	Yes	No
C. Radio Program	Yes	No
D. Radio Ad	Yes	No
E. Magazine Article	Yes	No
F. Magazine Ad	Yes	No
G. Newspaper Article	Yes	No
H. Newspaper Ad	Yes	No
I. Internet or Web	Yes	No
J. Outdoor billboards or outdoor posters	Yes	No
K. From friends or family	Yes	No
L. Some other place (Specify)__________	Yes	No

[PROGRAMMER NOTE: IF “Yes” TO Q18 THEN ASK Q20]

Q20. Can you briefly describe any public service advertising about drunk driving that you remember seeing or hearing recently?

(Please be as specific as possible while entering your answer in the space provided below.)

_______________

• Not applicable – I don’t remember any drunk driving prevention ads.

Q21. Are you aware of a public service advertising campaign with the slogan “Friends Don’t Let Friends Drive Drunk”?

1 Yes

2 No

Q22. Do you recall seeing any public service advertising that features home video footage taken in happier times of victims killed by drunk drivers? Various ads show footage of young children playing together, or a college student singing with her friends, or a young man celebrating his graduation from a military academy. The advertising ends with the slogan, “Friends don’t let friends drive drunk”. Have you seen this public service advertising?

1 Yes

2 No

3 Not sure

Q23. Are you aware of any public service ads with the slogan “Buzzed Driving Is Drunk Driving”?

1 Yes

2 No

3 Not sure

[PROGRAMMER NOTE: IF “Yes” TO Q23 THEN ASK Q24] (Accept multiple responses.)

Q24. Where did you see or hear ads that said “Buzzed Driving Is Drunk Driving”?

A. TV Program	Yes	No
B. TV Commercial	Yes	No
C. Radio Program	Yes	No
D. Radio commercial	Yes	No
E. Magazine article	Yes	No
F. Magazine ad	Yes	No
G. Newspaper article	Yes	No
H. Newspaper ad	Yes	No
I. Internet or Web	Yes	No
G. Outdoor billboards or outdoor posters	Yes	No
H. From friends or family	Yes	No
I. Some other place (Specify)__________	Yes	No

Q25. In the past 30 days, have you seen any public service TV ads about drunk driving prevention sponsored by “Project Roadblock”?

[SHOW END FRAME OF PROJECT ROADBLOCK]

1 Yes

2 No

3 Not sure

Q25b. Are you aware of any drunk driving prevention public service ads with the slogan “Drive Sober or Get Pulled Over”?

1 Yes

2 No

3 Not sure

INTRO TO Q26:

On the next several screens you will see some TV public service ads. For each, please indicate whether or not you have seen it.

[RANDOMIZE ORDER Q26A AND Q26B AND Q26C AND Q28 AND Q28A AND Q28B AND 28C AND 28D]

Q26A. Below is a video file of a public service TV ad that you may have seen.

[PLAY “AMBULANCE VIDEO FILE]

Have you seen this public service ad?

1 Yes

2 No

3 Not sure

Q26B. Below is a video file of a public service TV ad that you may have seen.

[PLAY “HOSPITAL” VIDEO FILE]

Have you seen this public service ad?

1 Yes

2 No

3 Not sure

Q26C. Here is a description of a public service TV ad that you may have seen.

[INSERT MONTAGE OF BUZZED :10 SPOTS PHOTOBOARD AND DESCRIPTION]

Have you seen any of these this public service ads? (Please select as many as apply.)

1 Yes, I saw an ad like this on TV

2. Yes, I saw an ad like this online

3 No, I’ve never seen any ads like this

4 Not sure

Q28. Below is a video file of a public service TV ad that you may have seen.

[PLAY“HOUSE PARTY” VIDEO FILE]

Have you seen this public service ad?

1 Yes

2 No

3 Not sure

Q28A. Below is a video file of a public service TV ad you might see.

(Please note that the ‘forward’ button will appear at the bottom of the screen, once the ad is almost completed)

PN: Play video “BAR MATH”

Have you seen this public service ad?

1. Yes, I have seen this

2. No, I have not seen this ad

3. Not sure

Q28B. Below is a video file of a public service TV ad you might see.

(Please note that the ‘forward’ button will appear at the bottom of the screen, once the ad is almost completed)

PN: Play video “MONKEY IN THE MIDDLE”.

Have you seen this public service ad?

1. Yes, I have seen this

2. No, I have not seen this ad

3. Not sure

Q28C. Below is a video file of a public service TV ad you might see.

(Please note that the ‘forward’ button will appear at the bottom of the screen, once the ad is almost completed)

PN: Play video “2012 TV PSA 1”.

Have you seen this public service ad?

1. Yes, I have seen this

2. No, I have not seen this ad

3. Not sure

Q28D. Below is a video file of a public service TV ad you might see.

(Please note that the ‘forward’ button will appear at the bottom of the screen, once the ad is almost completed)

PN: Play video “2012 TV PSA 2”.

Have you seen this public service ad?

1. Yes, I have seen this

2. No, I have not seen this ad

3. Not sure

[IF AWARE OF ANY TV ADVERTISING Q26A OR Q26B OR Q26C OR Q26D OR Q28 OR Q28A OR Q28B OR 28C OR 28D]

Do you remember if you saw any ‘Buzzed Driving Is Drunk Driving’ PSAs on any of the following local TV stations? (Please select all that apply.)

1. ABC

2. Azteca America

3. CBS

4. FOX

5. Home Shopping Network

6. ION Television

7. MTV

8. My Network Television

9. NBC

10. PBS

11. Telemundo

12. The CW

13. Trinity Broadcast Network

14. Univision

15. Other (Specify___________)

16. None of the above

17. Not sure

INTRO TO Q29D_E: SHOW ON A SEPARATE SCREEN.

Again, thank you for your participation. The survey is almost done.

[SPLIT SAMPLE Q29D AND Q29E]

Q29D. Have you heard a public service ad on the radio that depicts a scene in the emergency room after a drunk driving crash? A doctor is treating a woman with a head injury and he tells her boyfriend to get out and stay in the waiting room. The boyfriend is upset and says, “I was just buzzed.” The doctor says, “Oh, in that case she is fine.” The boyfriend says, “Really??” And the doctor replies “Are you serious? Of course she’s not fine.” An announcer then says, “Buzzed driving. Maybe we should stop acting like it’s no big deal. Buzzed driving is drunk driving.”

Have you heard this public service ad on the radio?

1 Yes

2 No

3 Not sure

Q29E. Have you heard a public service ad on the radio that depicts a scene where two women are talking in a car while driving home from a party? As they are talking, the driver crashes the car. In the aftermath, her friend is in pain and says she has broken her arm. The driver is upset and she says, “I was just buzzed.” Her friend says, “Oh, in that case I’m fine” and you hear her arm snap back into place. The driver says, “Really? Are you serious?” And her friend replies “No I’m not serious!” and she cries out in pain. An announcer then says, “Buzzed driving. Maybe we should stop acting like it’s no big deal. Buzzed driving is drunk driving.”

Have you heard this public service ad on the radio?

1 Yes

2 No

3 Not sure

Q29I. Have you heard a public service ad on the radio that switches back and forth between two women who are telling two stories of how they went home from the bar last night. One woman, Sarah, decided to take a cab home and said that she got home safely, even though her cab driver had to swerve to miss a squirrel. The other woman, Ellen, drove home herself even though she had too much to drink. She swerved to miss a squirrel and hit a man on the street instead. An announcer says, “You have a choice. Don’t drive buzzed. Buzzed driving is drunk driving.”

Have you heard this public service ad on the radio?

1 Yes

2 No

3 Not sure

[RANDOMIZE ORDER Q29A/Q29B/Q29G/Q29J]

Q29A. Have you seen any of these ads in a newspaper, magazine, or some other place?

[INSERT PRINT MONTAGE]

1 Yes

2 No

3 Not sure

[SPLIT SAMPLE Q29B AND Q29G]

Q29B. Have you seen any of these ads on a billboard, poster or some other place?

[INSERT OOH MONTAGE]

1 Yes

2 No

3 Not sure

Q29G. Have you seen any of these ads on a billboard, poster or some other place?

[INSERT OOH MONTAGE2]

1 Yes

2 No

3 Not sure

Q29J. Have you seen any of these ads online?

[INSERT WEB BANNER MONTAGE]

1 Yes

2 No

3 Not sure

[ASK IF “YES” TO 23 or 26a or 26b or 26c or 26d or 28 or 28A OR 28B OR 28C OR 28D OR 29a or 29b or 29c or 29d or 29e or 29g or 29i OR 29J]

Q29c. In your opinion, how effective is the “Buzzed Driving Is Drunk Driving” advertising that you have seen or heard?

1. Extremely effective

2. Very effective

3. Somewhat effective

4. Not too effective

5. Not at all effective

These last few questions will help us divide the interviews into groups.

Q30. In a typical week, how much time do you spend accessing the Internet?

SP (Drop down box)

Under 1 hour [0]

1 to 2 hours [1]

3 to 4 hours [2]

5 to 9 hours [3]

10 to 19 hours [4]

20 to 29 hours [5]

30 to 39 hours [6]

40 hours or more [7]

Not sure [-1]

Q31. On a typical day, how many hours of TV do you watch?

SP (Drop down)

Under 1 hour [0]

1 to 2 [1]

2 to 3 [2]

3 to 4 [3]

4 to 5 [4]

5 to 8 [5]

8 to 10 [6]

10+ [7]

Not sure [-1]

Q32. On a typical day, how many hours do you spend listening to the radio?

SP (Drop down)

Under 1 hour

1 to 2 [1]

2 to 3 [2]

3 to 4 [3]

4 to 5 [4]

5 to 8 [5]

8 to 10 [6]

10+ [7]

Not sure [-1]

Q33. Are you the parent or guardian of any children under the age of 18 living in your household?

1. Yes

2. No

[PROGRAMMER NOTE: ASK Q34 IF YES TO Q33]

Q34. Please check the appropriate box if you have a child in that age category living in your household:

1 5 years old or younger

2 6-12 years old

3 13-17 years old

Q35. What is your marital status?

1 Never married (Single)

2 Living together but not married

3 Married

4 Separated

5 Divorced

6 Widowed

7 Prefer not to state

Q37. Do you live in the city, suburbs, or some other area?

1 City

2 Suburbs

3 Some other area

Q38. What state do you live in?

[DROP DOWN BOX WHICH INCLUDES ALL 50 STATES AND DISTRICT OF COLUMBIA]

AC16 In which state do you currently reside?

1. AK West	14. ID West	27. MT West	40. RI Northeast
2. AL South	15. IL Midwest	28. NE Midwest	41. TN South
3. AR South	16. IN Midwest	29. NV West	42. TX South
4. AZ West	17. KS Midwest	30. NH Northeast	43. UT West
5. CA West	18. KY South	31. NJ Northeast	44. VA South
6. CO West	19. LA South	32. NM West	45. VT Northeast
7. CT Northeast	20. ME Northeast	33. ND Midwest	46. SD Midwest
8. DC South	21. MD South	34. NC South	47. SC South
9. DE South	22. MA Northeast	35. NY Northeast	48. WA West
10. FL South	23. MI Midwest	36. OH Midwest	49. WI Midwest
11. GA South	24. MN Midwest	37. OK South	50. WV South
12. IA Midwest	25. MO Midwest	38. OR West	51. WY West
13. HI West	26. MS South	39. PA Northeast

14

NHTSA Form 1182